Mastectomy retaining nipple as well as areola

Mr Gordon and his colleagues describe mastectomy with areola preservation
(NEAT) in carefully selected cases, and point out the advantage of areola
preservation for the patient (April 2001 JRSM, pp. 185-186). However,
preservation of the outer nipple can further improve cosmesis without
compromising oncological principles.

Experience with total duct excision has shown that a demarcation exists
between the outer dermo-fibromuscular covering of the nipple and the central
duct core. This plane may be utilized to remove the apex of the nipple
containing the duct orifices, together with the central duct core, while
preserving the outer nipple. This operation, designated ‘core nipple
duct excision’, is readily combined with mastectomy. It leaves a
diminished (but much appreciated by the patient) nipple in continuity with the
areola.

The details of the operation and the relevant oncological considerations
have been described
fully1. Case 3 in
Gordon's paper would be eminently suited to this procedure, as would all cases
where low-grade cancer is reasonably distanced from the nipple ducts, as
required for the NEAT operation.